ICD-10-CM for Home Health Outreach StaffCMS has focused initiatives on Diabetes Diabetes is a national epidemic (CDC) ICD-10-CM codes align with the international classification systems

Integrated OASIS Solutions © RBC Limited 2015

ICD-10-CM for

Home Health Outreach Staff Webcast #2

Patricia W. Tulloch RN, BSN, MSN, HCS-D

RBC Limited Healthcare & Management Consultants

P: 845-889-8128 • E: [email protected]

www.rbclimited.com

Integrated OASIS Solutions 2 © RBC Limited 2015

Lay the Groundwork for Comprehensive SOC

Assessment

Accurate Case Mix

Appropriate Care Plan

Provide Current & Historical Data

All Relevant Medical Data

Clear Transmission of Prior Setting(s)

Regulatory Foundation

Communication

Referral Needs/Orders

Face to Face Encounter

Referral Data: Impact Overview


Objectives

Identify expanded medical documentation for Home

Health to assign accurate ICD-10-CM diagnosis codes;

Discuss disease specific medical documentation most

pertinent to home health providers;

Detail required medical documentation for common

home health diagnosis;

Utilize tools and tips to enhance accurate ICD-10-CM

diagnosis code selection and sequencing;

Apply ICD-10-CM to common case examples in the

home health setting that requires specific

documentation.


Why is Coding So Important?

Statistical Data – Track and trend best practice

variances; volume; complications; treatment patterns

Research for Enhanced Outcomes and Treatments

Reflects Patient Acuity for injury or illness; Plan of

Care centers on Codes and Severity Indices

Medical Necessity Determination

PPS Payment – HHRG calculation

Resource Allocation

Risk Adjustment for Quality Outcomes

Accurate Reimbursement for All Settings


Documentation is Key

All reported codes MUST be supported by

physician documentation in the medical record

Report an updated, accurate picture of patient’s

health status reflected in OASIS assessments and

clinical documentation

Report diagnoses and conditions which relate to

the patient’s CURRENT plan of care

Do NOT include conditions that have been

resolved or no longer effect patients functioning

and plan of care


Medical Documentation to Support ALL

Diagnoses

Diagnosis Details

Type of Disease or Injury

Acuity and Severity (Chronic or Acute)

With or without Signs and Symptoms

Etiology and/or manifestations of a disease

Laterality and anatomical location

With or without complications

External cause(s) of injury or illness

Specificity is Critical with ICD-10-CM

Intake Is Critical Here


Diabetes: A National Focus CMS has focused initiatives on Diabetes

Diabetes is a national epidemic (CDC)

ICD-10-CM codes align with the international classification systems for diabetes

Federal mandate to diagnosis and treat earlier to prevent complications

Increased code specificity to track and correlate with quality outcomes & costs

Diabetes is a risk adjuster for home health quality outcomes

Diabetes remains case mix for Home Health

35% of all acute hospitalizations are related DM


Type of Diabetes

Type 1:Juvenile

Type 2: NIDDM

Other

Drug Inducted

Post Surgical

Secondary

Gestational

Due to Genetic Defects

Treatment(s)

Long Term (Current) Use of Insulin?

Complications and/or Manifestations

DM: Documentation Must-Haves


More on Diabetes & Disorders

Significant Changes to Diabetes Mellitus

Five (5) DM Categories

E08 Diabetes Mellitus due to an underlying condition

E09 Drug or chemical induced diabetes mellitus

E10 Type 1 diabetes mellitus

E11 Type 2 diabetes mellitus

E13 Other specified diabetes mellitus

Expanded Combination Codes for DM and manifestations

of DM

Updated to reflect & align current clinical classifications

No longer classified to controlled/uncontrolled


Diabetic Code Selections

Selection Based on Clinical Documentation

Default to Type 2 if Unknown

Type of Diabetes

Body System Effected

Use of insulin

Complications

Manifestations

Reason for secondary diabetes mellitus

Remember

Use as many codes as necessary to detail a patient’s

condition, including complications & manifestations


I-10: Can No Longer Assume DM with

DM & Osteomyelitis

DM & Gangrene

Need MD Documentation

All Manifestations

Cardiomyopathy

Nephropathy

Neuropathy

Retinopathy

Angiopathy

Diabetic Ulcer

Diabetic Encephalopathy

All Complications (DKA; HNS; Coma; Gastroparesis;..)

More on Manifestations


One Common Scenario

Patient admitted to home health with new diagnosis

of Type 2 diabetes. SNV for diabetic teaching, insulin

management. HTN; Hypothyroidism.

ICD-9-CM ICD-10-CM

250.00 DM E11.9 Type 2 Diabetes mellitus

410.9 HTN without complications

244.9 Hypothyroidism I10 Essential (primary) HTN

V58.67 L-T Use Insulin E03.9 Hypothyroidism,

unspecified

Z79.4 L-T Use of Insulin


Another DM Case Scenario

Patient admitted post hospitalization for foot

amputation due to diabetic peripheral angiopathy;

vascular disease. Insulin dependent Type 2 diabetes

with gastroparesis secondary to the diabetes. COPD,

hypothyroidism.

Z47.81 Aftercare, following surgery (for) (on) amputation

E11.51 Type 2 diabetes with peripheral angiopathy

E11.43 Type 2 diabetes with gastroparesis

J44.9 COPD

E03.9 Hypothyroidism, unspecified

Z89.439 Absence of (complete or partial) foot (acquired)


Other DM Scenarios

Patient with diabetic nephrosis due to steroid use

T38.0x5D poisoning by adverse effect of glucocorticoids

and synthetic analogues

E09.21 Drug induced diabetes with kidney complications

Hypoinsulinemia due to postpancreatectomy

E89.1Postsurgical hypoinsulinemia

Use additional codes: E08; Z79.4; Z90.411

Diabetic amyotrophy

Neurogenic muscle weakness in the hips and back

Early complication of diabetes

E11.44 Type 2 Diabetes with diabetic amyotrophy


CV Diseases & Disorders

Valve Disorders

Coded by Location & Etiology

Conduction Disorders

Blocks; Arrhythmias

Ischemic Heart Disease

Chronic Ischemic Heart Disease

Heart Failure (I50.-)

Acute Myocardial Infarctions (I21.-; I22.-)

Cerebrovascular Disease (I60-I69)

Sequelae: Residuals Post Acute CVA I69.-


HTN (Assumption Code Still in Place with CKD)

Includes all types of HTN except

HTN due to any condition

Gestational

Lupus

Other

Atrial Fibrillation

Type

Paroxysmal

Persistent

Chronic

Fibrillation versus Flutter

Documentation Needs


ICD-10-CM HTN

I10 Essential HTN

Includes: Arterial; Benign; Malignant; Unspecified

I11.0 Hypertensive Heart Disease with Heart

Failure

Use additional code for heart failure I50.-

I11.9 Hypertensive Heart Disease without Heart

Failure

I12 Hypertensive CKD

Use additional code for CKD (N18-)

I13 Hypertensive Heart & Chronic Kidney Disease

with Stage 5 CKD or End Stage Renal Disease


More on HTN

I15 Secondary HTN

Code also the underlying condition

I15.0 Renovascular HTN

I15.1 HTN secondary to other renal disorders

I15.2 HTN secondary to endocrine disorders

I15.8 Other secondary HTN

I15.9 Secondary HTN, unspecified

Sequencing for Secondary HTN is determined by

the encounter needs

Discretionary based on the Plan of Care


Case Scenario

Patient admitted post hospitalization with a chronic nonhealing

stage 3 decubitus ulcer of the right ankle. Patient is a Type 1

diabetic with peripheral vascular disease due to the diabetes.

Stage 4 CKD, HTN, hypercholesterolemia, status post BKA.

L89.513 Pressure ulcer, stage 3, ankle

E10.51 Type 1 diabetes with peripheral angiopathy

I12.9 Chronic hypertensive kidney disease (Stage 1-4)

N18.4 Stage 4 (severe) CKD

E78.0 Hypercholesterolemia

Z89.52 Absence, limb, below the knee (acquired)


More Case Scenarios

Stage III CKD, HTN, mild chronic heart failure

I12.9 Hypertensive CKD with Stage 1 through Stage 4 or

unspecified CKD

N18.3 CKD, Stage III (moderate)

I50.9 Heart Failure, Unspecified

COPD; Hypertensive Heart Disease with Heart

Failure; Oxygen Dependent

J44.9 Pulmonary, chronic obstructive

I11.0 Hypertensive Heart Disease with Heart Failure

I50.9 Heart Failure, unspecified

Z99.81 Oxygen (long term) (supplemental)


Heart Valve Disorders

Stenosis

Narrowing of valve orifice (calcification)

Prolapse

Most Common Valve Disorder

5-10% of population

Mitral Valve Prolapse (MVP)

“Click Murmur” or “Barlow’s Syndrome”

Regurgitation

Valve Insufficiency

Does not close properly

Backflow


Valve Disorders Documentation Needs: Valve Disorders

Type of Disorder

Valve(s) Involved

Cause of disorder, if applicable

Congenital or non-congenital

I05.0 Rheumatic Mitral Stenosis

I05.1Rheumatic Mitral Insufficiency

I07.0 Rheumatic Tricuspid Stenosis

I34.1 Nonrheumatic Mitral Valve Prolapse

I35.1 Nonrheumatic Aortic Valve Insufficiency

I37.0 Nonrheumatic Pulmonary Valve Stenosis


Angina: I20.0-I20.9

Angina Pectoris

Discomfort or pain in Chest

Inadequate Blood Supply to the Heart

Early Warning Sign of AMI

Code Selection

Based on Type of Angina

Other Code Guidance

When using a combination code that includes

atherosclerosis, it is NOT necessary to use an additional

code for angina pectoris

A Causal relationship is assumed with atherosclerosis and

angina, unless the documentation indicates otherwise


Angina Diagnoses

I20.0 Unstable Angina

Accelerated; Crescendo; De Nove; Intermediate Coronary

Syndrome; Preinfarction Syndrome; Worsening Effort

Angina

I20.1 Angina Pectoris with Documented Spasm

I20.8 Other Forms of Angina

Angina equivalent; Angina of effort; Coronary slow flow

syndrome; Stenocardia

I20.9 Angina Pectoris, Unspecified

Angina NOS; Anginal syndrome; Cardiac angina;

Ischemic chest pain


One Case Scenario

Patient admitted home health with Unstable Angina,

HTN, CHF, DM controlled with oral hypoglycemics.

I20.0 Unstable Angina

I50.9 Congestive Heart Failure NOS

I10 Essential (Primary) Hypertension

E11.9 Type 2 Diabetes without complications


Ischemic Heart Disease: I25

Etiology

Narrowing of coronary arteries

Code Selection

Location of Blockages

Past Medical History & Symptomatology

Type of Angina, if applicable

Code Guidance

When using one of these combination codes it is NOT

necessary to use an additional code for angina pectoris

A causal relationship is assumed with atherosclerosis

and angina, unless the documentation indicates

otherwise


Type and Complication(s)

Angina Pectoris

Unstable (accelerated; crescendo; intermediate

coronary syndrome)

With Documented Spasm (angiospastic; prinzmetal;

variant)

Other Forms (coronary slow flow syndrome;

stenocardia; ischemic chest pain)

ASHD + Angina

CAD with Angina

Cause and Effect Assumed by Coder

Other Complications & Treatments

Documentation Needs


Ischemic Heart Diagnoses I25.10 Atherosclerotic heart disease of native artery

without angina pectoris

I25.110 Atherosclerotic heart disease of native coronary

artery with unstable angina pectoris

I25.111 Atherosclerotic heart disease of native artery with

angina pectoris with documented spasm


artery with other forms of angina pectoris


artery with unspecified angina pectoris

I25.2 Old myocardial infarction

I25.3 Aneurysm of heart

I25.41 Coronary artery aneurysm


More Ischemic Heart Dx Codes

I25.41 Coronary artery aneurysm

I25.42 Coronary artery dissection

I25.5 Ischemic cardiomyopathy

I25.6 Silent myocardial ischemia

I25.7--Atherosclerosis of coronary artery bypass grafts

and coronary artery of transplanted heart with angina

pectoris

See Multiple Codes Here

I25.8– Other forms of chronic ischemic heart disease

See Multiple Codes Here

I25.9 Chronic ischemic heart disease, unspecified

Ischemic Heart Disease (Chronic) NOS


CHF Documentation Needs

Code Selection

Acute/Chronic/Acute on Chronic

Type of Failure (Systolic; Diastolic)

Location: Right/Left

Guidelines

Code etiology first if indicated

Heart failure following surgery: I97.13-

Heart Failure due to HTN: I11.0

Rheumatic Heart Failure: I09.81

Heart Failure Should Always Listed in First 6

Diagnoses for Home Care


Common HF Diagnoses

I50.1 Left Ventricular Failure

I50.20 Unspecified systolic (congestive) HF

I50.21 Acute systolic (congestive) HF

I50.22 Chronic systolic (congestive) HF

I50.23 Acute on chronic systolic (congestive) HF


I50.30 Unspecified diastolic (congestive) HF

I50.31 Acute diastolic (congestive) HF

I50.32 Chronic diastolic (congestive) HF

I50.33 Acute on chronic diastolic (congestive) HF


Date of MI is Critical

Date of Sequential MI is Critical

Acute MI = 4 weeks (28 days)

Type of MI

STEMI

Anterior wall (left main coronary artery; left anterior

descending coronary, other)

Inferior wall (right coronary artery. Other)

Other sites (Circumflex)

Non-STEMI

Subendorcardial MI; Transmural MI

STEMI to NSTEMI: Due to thrombolytic therapy

MI Documentation Needs


AMI Diagnosis Codes

I21.01 ST elevation MI involving the left main coronary

artery

I21.02 ST elevation MI involving the left anterior

descending coronary artery

I21.09 ST elevation MI involving other coronary artery of

anterior wall

I21.11 ST elevation MI involving right coronary artery

I21.19 ST elevation MI involving other coronary artery of

inferior wall

I21.21 ST elevation MI involving left circumflex coronary

artery

I21.9 ST elevation MI involving other sites


More AMI Diagnosis Codes

I21.3 ST elevation MI of unspecified site

I21.4 Non-ST elevation MI

I22.0 Subsequent ST elevation MI of anterior wall

I22.1 Subsequent ST elevation MI of inferior wall

I22.2 Subsequent ST elevation MI myocardial infarction

I22.8 Subsequent ST elevation MI of other sites

I22.9 Subsequent ST elevation MI of unspecified site

Remember: Use the I22 codes for a patient who

has a second MI within the 4 week timeframe of

the initial AMI


Pulmonary Disease

COPD is a Primary or Secondary Diagnosis for over

20% of all Home Care Patients

COPD, is a no longer a case mix diagnosis for home health

COPD is a chronic disease that impacts every home health

Plan of Care – without exception

COPD impacts Acute Hospitalization

and Emergent Care Rates

Higher Risk of Uncontrolled Symptoms

Higher Risk of Falls

Higher Risk of Infections

Higher Risk of Complications


COPD versus Emphysema

Acute or Chronic

Infections agent (Streptococcus; Coxsackie virus;

Mononucleosis; etc.) if indicated

Asthma

Mild, moderate or severe

Intermittent or Persistent

Uncomplicated, with exacerbation, with status asthmaticus

Exposure to tobacco smoke

Pneumonia

Vital or bacterial; Causal Agent

Anatomical location (Lobular; bronchopneumonia)

Documentation Needs


COPD Diagnosis Examples

J44: Other chronic obstructive pulmonary disease

Code also type of asthma

Use additional codes as well

J44.0 Chronic obstructive pulmonary disease with

acute lower respiratory infection

Use additional code to identify the infection

J44.1 Chronic obstructive pulmonary disease with

(acute) exacerbation

Decompensated COPD

J44.9 Chronic obstructive pulmonary disease,

unspecified (COPD NOS)


Emphysema J43 Emphysema

Use additional code to identify

Exposure to environmental tobacco smoke (Z77.22)

Exposure to tobacco smoke in the perinatal period (Z96.81)

History of tobacco use (Z87.891)

Occupational exposure to environmental tobacco smoke (Z57.31)

Tobacco dependence (F17-_

Tobacco use (Z72.0)

J43.0 Unilateral pulmonary emphysema (MacLeod’s

Syndrome)

J43.1 Panlobular emphysema

J43.2 Centrilobular emphysema

J43.8 Other emphysema

J43.9 Emphysema, unspecified


Asthma Diagnosis Examples

Documentation Needs Severity of disease

Whether acute exacerbation exists

Whether status asthmaticus exists

Code additional codes as indicated

J45.20 Mild intermittent asthma, uncomplicated

J45.21 Mild intermittent asthma with (acute) exacerbation

J45.22 Mild intermittent asthma with status asthmaticus

J45.32 Mild persistent asthma with status asthmaticus

J45.901 Unspecified asthma with (acute) exacerbation

J45.902 Unspecified asthma with status asthmaticus

J45.909 Unspecified asthma, uncomplicated


Common Case Scenario

Patient admitted post hospitalization for acute

transmural anterior wall STEMI. Parkinson’s;

asthma; diabetes controlled by oral hypoglycemics.

I21.09 ST elevation (STEMI) MI involving other coronary

artery of anterior wall

G20 Parkinson’s Disease

J45.909 Unspecified Asthma, uncomplicated

E11.9 Diabetes, Type 2


Pharyngitis

Acute or Chronic

Infectious Agent (Streptococcus; coxsackie virus;

mononucleosis;….)

Pneumonia

Viral or Bacterial

Causal Organism (E.Coli; MRSA;..)

Anatomical Location

Lobular

Bronchopneumonia

Treatment(s)

Pharyngitis & Pneumonia


Pneumonia Specificity

J12 Viral Pneumonia, not elsewhere classified

Code first associated influenza, if applicable

JJ13 Pneumonia due to Streptococcus pneumonias

J14 Pneumonia due to Hemophilus influenzae

J15.0 Pneumonia due to Klebsiella pnumoniae

J15.1 Pneumonia due to Pseudomonas

J15.211 Pneumonia due to Methicillin susceptible

Staphylococcus aureus

J15.212 Pneumonia due to Methicillin resistant

Staphylococcus aureus

J18.0 Bronchopneumonia, unspecified organism

J18.9 Pneumonia, unspecified organism


Case Scenario

Patient has pneumonia due to Hemophilus

influenza. Chronic obstructive lung disease with

lower respiratory infection; Nicotine dependence

J14 Pneumonia due to Hemophilus influenza

J44.0 Chronic obstructive pulmonary disease with lower

respiratory infection

F17.218 Nicontine dependence, cigarettes, with other

nicotine induced disorders

Document Infectious Agent If Known


Flu Season is Here Causes

Viruses

Types

Two Main Types

Type A (includes H1N1)

Type B (less common)

Code Selection

Virus

Manifestation(s)

Remember

Code Guidelines: Clear diagnostic statements

Default Code: J11.1 (Influenza NOS)


Influenza

Influenza due to certain identified viruses

Only confirmed cases of influenza due to certain influenza

viruses are reported

Influenza due to certain unidentified viruses

“Probable”, “Suspected”, “Possible”

J11.1 Influenza due to unidentified influenza virus with

gastrointestinal manifestations

Manifestations or Complications of Influenza

GI Symptoms

Respiratory conditions

Pneumonia

Documentation Needs


Influenza Diagnosis Examples

J09.x1 Influenza due to identified novel influenza A virus

with pneumonia


with other respiratory manifestations


with gastrointestinal manifestations

J09.X9 Influenza due to identified novel influenza A virus

with other manifestations

J10.1 Influenza due to other identified influenza virus with

respiratory manifestations

J10.89 Influenza due to other influenza virus with other

manifestations


More on Influenza Data

Multiple Codes may be used to report a case of

influenza

J09: Use additional codes for manifestations

J85.1 lung abscess

J91.8 pleural effusion

J01.- sinusitis

J10: Use additional code to identify virus

Code also type of pneumonia

Use additional codes for manifestations

Influenza may be a primary or secondary

diagnosis, depending on the Plan of Care

Coders MUST read ALL instructional notes


Common Case Scenarios

Acute bronchitis due to Streptococcus A; mild

chronic heart failure

J20.2 Acute bronchitis due to streptococcus

I50.9 Heart Failure, Unspecified

Influenza due to other identified influenza virus

with otitis media; Hypertensive Heart Disease

with Heart Failure; Oxygen Dependent

J10.83 Influenza due to other identified influenza virus

with otitis media

I11.0 Hypertensive Heart Disease with Heart Failure


Z99.81 Oxygen (long term) (supplemental)


Neoplasm Terminology

Malignant Primary

Malignant Secondary (metastatic)

Ca In Situ

Benign

Uncertain behavior

Unspecified behavior

Anatomical Specificity

Specific anatomical location is key

Lung Cancer: (Which lung?; Which lobe?)

Breast Cancer: (Which breast?; Which quadrant?)

Neoplasms


Type (Topography) and Site

Primary

Melanomas

Merkel cell carcinomas

Mesotheliomas

Excludes

Neuroendocrine tumors

Lymphoid

Hemapoietic (ex. Hodgkin’s Lymphoma)

Example: Adenocarcinoma of Transverse Colon

Specific Type; Specific Location

Malignant Neoplasms


Leukemia

Type

Lymphoid; myelomonocytic; promyelocytic; erythroid; mast

cell; ………

Current or In Remission

In Relapse

Lymphoma

Type

Nodular lymphocyte predominant; nodular sclerosis classical;

mixed cellularity classical; lymphocyte-depleted classical;

lymphocyte-rich

What Location?

Treatment Options & Plans

More on Neoplasms


Type

Basal Cell Carcinoma

Squamous Cell Carcinoma

Carcinoma in situ

Melanoma in-situ

Anatomical Location & Laterality

Right or left

Forearm; Shoulder; Face; etc……

Site Specific

For diagnosis In-Situ and/or Melanomas

Skin Cancer


Anemia

Type

Chronic or Acute

Treatment(s)

Anemia and Malignancy

Type & Site of Cancer

Anemia “due to” or “because of”

Anemia as Adverse Effect of Chemotherapy

and/or Treatment

Nutritional Deficits

Treatment(s)

Anemia


Adverse Effect of Chemotherapy

Documentation Must Include

Adverse Effect: Sign or Symptom

Drug or Therapy: Chemotherapy or Radiation

Reason for Therapy: Cancer (Type; Location; Laterality)

One Example

Fever and chills due to adverse effect of chemotherapy,

carcinoma of the pancreas

R50.9 Fever, unspecified

T45.1x5D Adverse effect of antineoplastic and

immunsuppressive drugs, subsequent encounter

C25.9 Malignant neoplasm of pancreas, unspecified

More on Chemo Impact


Elderly debilitated patient with left breast carcinoma.

Secondary malignant neoplasm of the liver. Severe

anemia secondary to malignancy. Refuses treatment.

Cachexic. Pain secondary to malignancy. DNR.

Primary: C50.912 Malignant neoplasm of unspecified

site of left female breast

Secondary: C78.7 Secondary neoplasm of the liver

D63.0 Anemia secondary to neoplasm

G89.3 Neoplasm Pain

R64 Cachexia

Z66 DNR

Case Scenario


MD Documentation is Critical

Etiology

Complications

Manifestations

Treatments

Pain

Site specific

Cause (Neoplasm; Trauma; Chronic; Other)

Dementia

Identify cause if known (Alzheimer’s; Parkinson’s…)

If cause is not known

Identify behavior Issues (wandering; irritation; combative…)

Bottom Line on I-10-CM Diagnoses


Site –Specific Pain (Acute or Chronic?)

Location & Laterality

Cervicalgia

Left or Right Knee

RUQ Abdomen

Pain due to Neoplasm

What Type of Cancer?

Location & Laterality

Chronic Pain Syndrome

Pain due to Trauma

What Kind of Trauma?

Fracture or Contusion? Cause?

Pain


Case Scenarios

Patient has acute neck pain secondary to falling

down stairs.

G89.11 Acute Pain due to Trauma

M54.2 Cervicalgia

W10.9xxD Fall on or from unspecified steps/stairs

Patient has neoplasm pain secondary to liver cancer.

G89.3 Neoplasm Pain

C22.9 Malignant neoplasm of the liver, not specified

as primary or secondary


Documentation Needs: Specificity

Lumbago or Lower Back Pain

Pain due to Intervertebral Disc Disorder

Site of Spine?

Associated radiculopathy, myelopathy, other complications

and/or manifestations

Back and Flank Pain

Other manifestations and

complications

Pregnancy

Kidney Stone

UTI

Back Pain


Cystitis (Kidney or Bladder Infection)

Acute or Chronic

With/without Hematuria

By Type: Interstitial; Trigonitis; Irradiation

UTI

Only used when site is not identified

Explore additional data to identify infectious agent

CKD Specificity

Stage (1-5 or ESRD)

Mild (Stage 2); Moderate (Stage 3); Severe (Stage4)

Is patient on Dialysis?

Urinary Tract Infection (UTI)


Alzheimer’s Specificity

ICD-10-CM Tabular Instructions

“Use additional code”

MUST Code Dementia with or without behavioral

disturbance with Alzheimer’s Disease

G30 Series

G30.0 Alzheimer’s disease with early onset

G30.1 Alzheimer’s disease with late onset

G30.8 Other Alzheimer’s disease

G30.9 Unspecified Alzheimer’s Disease

Follow Physician Documentation for Onset

Code G30.9 when no specific documentation exists

about the age of disease onset


72 year old male admitted Home Health with

primary dx of anemia secondary to lung cancer.

Alzheimer’s with late onset. History of tobacco

use.

C34.90 Malignant neoplasm of unspecified part of

unspecified bronchus or lung

D63.0 Anemia in neoplastic disease

G30.1 Alzheimer’s Disease with Late Onset

F02.80 Dementia in other diseases classified

elsewhere without behavioral disturbance

Z87.891 History of tobacco use

Case Scenario


Common Case Scenario Patient post hospitalization for end stage COPD.

Daughter is caregiver. Patient has dementia with

increased behavioral disturbance, including

wandering. HTN.

J44.1 COPD, end stage

F03.91 Dementia, unspecified, with behavioral disturbance

I10 HTN

Z91.83 Wandering in diseases

classified elsewhere


Multiple Sclerosis: G35

Multiple Sclerosis

Demyelinating Disease of the Central Nervous System

MS G35 Includes:

Disseminated multiple sclerosis

Generalized multiple sclerosis

Multiple sclerosis NOS

Multiple sclerosis of brain stem

Multiple sclerosis of cord

Primary or Secondary Diagnosis

List all Pertinent Diagnoses on Plan of Care

Resources: National MS Society


Epilepsy: G40

Brain Disorder in which clusters of brain cells

send abnormal signals to the body

Causes

Trauma

Congenital

Drug induced

Other

Code Selection

Type of Epilepsy

Intractable or not intractable

With or without status epilepticus


ICD-10-CM Epilepsy Examples

G40 Epilepsy and recurrent seizures

G40.001 Localization–related (focal)(partial) idiopathic

epilepsy and epileptic syndromes with seizures of localized

onset, not intractable, with status epilepticus

G40.009 Localization-related (focal)(partial) idiopathic

epilepsy and epileptic syndromes with seizures of localized

onset, not intractable, without status epilepticus

G40.101 Localization-related (focal)(partial) symptomatic

epilepsy and epileptic syndromes with simple partial seizures

not intractable, with status epilepticus

G40.109 Localization-related (focal)(partial) symptomatic

epilepsy and epileptic syndromes with simple partial seizures

not intractable, without status epilepticus


CP & Other Paralytic Syndromes Cerebral Palsy

Usually appears before the age of 3

Underdeveloped or damaged brain cells impact movement,

learning, hearing, sight, and thinking

Hemiplegia

Complete paralysis of one entire side of body

Congenital or acquired

Paraplegia

Paralysis of lower extremities

Acquired or congenital

Monoplegia

Paralysis of one limb


More Diagnosis Examples

G81.90 Hemiplegia, unspecified affecting unspecified site

G81.91 Hemiplegia, unspecified affecting right dominant side

G81.92 Hemiplegia, unspecified affecting left dominant side

G81.93 Hemiplegia, unspecified affecting right nondominant

G82.20 Paraplegia, unspecified

G82.21 Paraplegia, complete

G82.22 Paraplegia, incomplete

G82.50 Quadriplegia, unspecified

G82.51 Quadriplegia, C1-C4 complete

G82.52 Quadriplegia, C1-C4 incomplete

G82.53 Quadriplegia, C5-C7 complete

G82.54 Quadriplegia, C5-C7 incomplete


Obstetrics Requires Documentation

Final character for trimester of pregnancy

Trimester based on provider documentation

Routine Outpatient Prenatal Visits: Z34

Routine Prenatal for High Risk Pregnancies: O09

Diagnosis Code Guidelines

Pre-existing conditions versus conditions due to the

pregnancy: Follow Manual Instructions Gestational Diabetes versus Diabetes mellitus prior to pregnancy (O24)

Pre-existing HTN complicating pregnancy (O10)

Post Partum Complications: 6 weeks

Pregnancy Associated Cardiomyopathy: O93.3

Sequelae of Pregnancy: O94


Alcohol and/or tobacco use during pregnancy,

childbirth and puerperium

O99.31 Alcohol use during pregnancy……

Code also F10- to indicate Alcohol related disorders, to

identify manifestations of alcohol use

O99.33 Smoking (tobacco) complicating pregnancy…..

Assign for any mother who uses tobacco products during

pregnancy

Code also F17, nicotine dependence OR Z72.0, tobacco use

HIV Status

O98.7- HIV related illness complicating pregnancy..

Z21 Asymptomatic HIV infection status

Complications or Status


One Case Scenario

Patient seen with a gestation period of 29 weeks, for

gestational diabetes. She requires close monitoring of

her blood sugars for the possibility of starting insulin.

O24.410 Gestational diabetes mellitus in pregnancy, diet

controlled

O09.893 Supervision of other high risk pregnancies,

third trimester


More Case Scenarios 36 year old G2P1 woman admitted is now 26 weeks

pregnant and being seen for gestational

hypertension.

O13.2 Pregnancy complicated by HTN

O09.522 Single pregnancy, elderly, multigravida

Z3A.26 Single pregnancy, 26 weeks gestation

16 week pregnancy with mild hyperemesis and UTI,

E.Coli.

O21.0 Hyperemesis, pregnancy

O23.42 Pregnancy complicated by urinary infection

B96.20 Infection, E.coli

Z3A.16 Pregnancy, 16 weeks gestation


Many ICD-10 Challenges

Documentation Needs

Requires increased specificity in the clinical documentation

Specific Documentation Needs

Laterality; Severity; Specific Affected site; Clinical Specificity

Examples:

Atherosclerotic heart disease heart disease of native coronary

artery with unstable angina pectoris (I25.110)

Rheumatic aortic valve diseases (I06)

STEMI MI involving left anterior descending coronary artery

(I21.02)

Hemiplegia & hemiparesis following cerebral infarction affecting

right dominant side (I69.351)

Clinicians: Increased A & P for 2015 and Beyond


Agency Risk Areas: ICD-10

Reimbursement Issues: Backlogs; Claims Denials

Allocating Adequate ICD-10-CM Resources

Dual Coding and Testing

Monitoring and Compliance Oversight

Adequate Systemic Implementation Planning

Comprehensive Agency ICD-10Assessment

Monitor Vendor and Partner Preparedness

Lack of Access to Precise Physician Documentation

Ensure Accurate ICD-10 Code Assignment

Specialty Resource Access During Transition

Oversight and Monitoring of ICD-10 Compliance and Impact


Resource Web Sites

www.cms.hhs.gov

Centers for Medicare & Medicaid Services

PPS Federal Register

www.cdc.gov

Centers for Disease Control

Official ICD-9-CM Code Guidelines

www.ahima.org

AHIMA (American Health Information Management Association)

www.cms.hhs.gov/HomeHealthQualityInits/12_HHQIOOASISUSERManual.asp

OASIS User’s Manual Revised 12/12

www.medicalspecialtycoding.com

Board of Advanced Medical Coding


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ICD-10-CM Sample Diabetes Diagnosis Crosswalk © RBC Limited 2014

SAMPLE ICD-10-CM DIABETES CROSSWALK

ICD-9-CM Diagnoses ICD-10-CM Code Equivalent(s)

250.00 Diabetes mellitus without mention of

complication, type II or unspecified type, not stated as

uncontrolled

E11.9 Type 2 diabetes mellitus without complications

E13.9 Other specified diabetes mellitus without complications


complication, type 1 (juvenile type), not stated as

uncontrolled

E10.9 Type 1 diabetes mellitus without complications


complication, type II or unspecified type, uncontrolled

E11.65 Type 2 diabetes mellitus with hyperglycemia


complication, type 1, stated as uncontrolled

E10.65 Type 1 diabetes with hyperglycemia

250.40 Diabetes with renal manifestations, type 2 or

unspecified, not stated as uncontrolled

E11.21 Type 2 diabetes mellitus with diabetic nephropathy

E11.22 Type 2 diabetes with diabetic chronic kidney disease

E11.29 Type 2 diabetes with other diabetic kidney complications

E13.21-E13.29 Reference Code Manual for Details

250.50 Diabetes with ophthalmic manifestations, type 2

or unspecified type, not stated as uncontrolled

E11.311 Type 2 diabetes mellitus with unspecified retinopathy with macular

edema

E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without

macular edema

E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy

with macular edema

E11.329 - E11.39 Reference Code Manual for Details

250.60Diabetes with neurological manifestations, type 2

or unspecified, not stated as uncontrolled

E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly) neuropathy

E11.44 Type 2 diabetes mellitus with diabetic amytrophy

E11.49 Type 2 diabetes mellitus with other diabetic neurological complication

E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy

E13.40 - E13.610 See Code Manual Details

ICD-10-CM Sample Diabetes Diagnosis Crosswalk © RBC Limited 2014

ICD-9-CM Diagnoses ICD-10-CM Code Equivalent(s)

250.70 Diabetes with peripheral circulatory disorders,

type 2 or unspecified type, not stated as uncontrolled

E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without

gangrene

E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with

gangrene

E11.59 Type 2 diabetes mellitus with other circulatory complications

E13.51 - E13.59 See Code Manual

250.80 Diabetes with other specified manifestations, type

2 or unspecified type, not stated as uncontrolled

E11.618 Type 2 diabetes with other diabetic arthropathy

E11.620 Type 2 diabetes with diabetic dermatitis

E11.621 type 2 diabetes with foot ulcer

E11.622 Type 2 diabetes with other skin ulcer

E11.628 Type 2 diabetes with other skin complications

E11.630 Type 2 diabetes with periodontal disease

E11.638 Type 2 diabetes with other oral complications

E11.649 Type 2 diabetes with hypoglycemia without coma

E11.65 Type 2 diabetes with hyperglycemia

E11.69 Type 2 diabetes with other specified complication

E13.618 - E13.69 See Code Manual

250.81 Diabetes with other specified manifestations, type

1 (juvenile type), not stated as uncontrolled

E10.618 Type 1 diabetes mellitus with other diabetic arthropathy

E10.620 Type 1 diabetes mellitus with diabetic dermatitis

E10.621 Type 1 diabetes mellitus with foot ulcer

E10.622 Type 1 diabetes mellitus with other skin ulcer

E10.628 Type 1 diabetes mellitus with other skin complications

E10.630 Type 1 diabetes mellitus with periodontal disease

E10.638 Type 1 diabetes mellitus with other oral complications

E10.649 Type 1 diabetes mellitus with hypoglycemia

E10.65 Type 1 diabetes mellitus with hyperglycemia

E10.69 Type 1 diabetes mellitus with other unspecified complications

250.90 Diabetes with unspecified complication, type 2 or

unspecified type, not stated as uncontrolled

E11.8 Type 2 diabetes with unspecified complications

E13.8 Other specified diabetes mellitus with unspecified complications

250.91 Diabetes with unspecified complication, type 1

(juvenile type), not stated as uncontrolled

E10.8 Type 1 diabetes mellitus with unspecified complications

ICD-10-CM Sample Diagnosis Crosswalk © RBC Limited 2014

ICD-10-CM SAMPLE CROSSWALK

ICD-9-CM Diagnoses ICD-10-CM Code Equivalent(s) Additional Information

V54.81 Aftercare following

Joint replacement

Z47.1 Aftercare following Joint Replacement

Therapy

Identical

781.2 Abnormal Gait R26.0 Ataxic Gait

R26.1 Paralytic Gait

R26.89 Other Abnormalities of Gait & Mobility

R26.9 Unspecified Abnormalities of Gait & Mobility

Approximate

728.87 Generalized Muscle

Weakness

M62.81 Muscle Weakness, Generalized Identical

V15.88 History of Falls Z91.81 History of Falls Identical

428.0 Congestive Heart

Failure

I50.9 Heart Failure, Unspecified Approximate

401.9 Essential

Hypertension, Unspecified

I10 Essential (Primary) Hypertension Approximate

427.31 Atrial Fib I48.0 Atrial Fibrillation Identical

496 COPD NOS J44.9 Chronic Obstructive Pulmonary Disease,

Unspecified

Approximate

491.21 Obstructive

Chronic Bronchitis with

Acute Exacerbation

J44.1 Chronic Obstructive Pulmonary Disease with

Acute Exacerbation

Approximate

492.8 Emphysema J43.9 Emphysema, Unspecified Identical

486 Pneumonia J18.0 Bronchopneumonia, unspecified organism

J18.1 Lobar pneumonia, unspecified organism

J18.2 Hypostatic pneumonia, unspecified organism

J18.8 Other pneumonia, unspecified organism

J18.9 Pneumonia, unspecified organism

Approximate

311 Depression F32.9 Depression NOS Approximate

300.00 Anxiety F41.9 Anxiety Disorder, Unspecified Identical

331.0 Alzheimer’s Disease G30.9 Alzheimer’s Disease, Unspecified Approximate

332.0 Parkinson’s Disease

NOS

G20 Parkinson’s Disease Approximate



340 MS G35 Multiple Sclerosis Identical

290.0 Senile Dementia F03 Unspecified Dementia Approximate

294.10 Dementia in

diseases classified

elsewhere without

behavioral changes

F02.80 Dementia in other diseases classified elsewhere

without behavioral changes

Identical

294.11 Dementia in

diseases classified

elsewhere, with behavioral

changes

F02.81 Dementia in other diseases classified elsewhere

with behavioral changes

Identical

599.0 Urinary Tract

Infection, Site Not

Specified

N39.0 Urinary Tract Infection, Site Not Specified

N30.00 Acute cystitis without hematuria

Identical

596.54 Neurogenic

Bladder

N31.9 Neuromuscular dysfunction of bladder,

unspecified

Identical

585.9 CKD, Unspecified N18.9 CKD, Unspecified Identical

585.6 ESRD N18.6 End Stage Renal Disease Z99.2 Additional Code for Dialysis Status

438.21 CVA with

dominant Hemiplegia

I69.351 Hemiplegia and Hemiparesis affecting right

dominant side

I69.352 Hemiplegia and Hemiparesis affecting left

dominant side

I69.353 Hemiplegia and Hemiparesis affecting right

non dominant side

I69.354 Hemiplegia and Hemiparesis affecting left

non dominant side

Approximate

438.82 CVA with

Dysphagia

I69.391 Dysphagia following cerebral infarction Use additional code for dysphagia R13.1-

787.20 Dysphagia R13.10 Dysphagia, Unspecified Approximate

530.81 GERD K21.0 Gastro-esophageal reflux disease with

esophagitis

K21.9…..without esophagitis

Identical



250.00 Diabetes Mellitus

without mention of

complication, Type 2 or

Unspecified Type, not

stated as uncontrolled

Ell.9 Type 2 Diabetes Mellitus without Complications Approximate

440.20 Atherosclerosis I70.201 Unspecified atherosclerosis of native arteries

of extremities, right leg

Approximate

440.23, 707.1x

Atherosclerosis with

ulceration

I70.23 Atherosclerosis of native arteries of right leg

with ulceration

I70.24 Atherosclerosis of native arteries of left leg

with ulceration

6th

character specified exact location on leg

1-thigh

2-calf

3-ankle

4-heel and midfoot

5-other part of foot

8-other part of lower leg

9-unspecified site

Use additional code to identify severity of

ulcer(I97 with 5th

character “1”)

443.9 PVD I73.9 Peripheral vascular disease, unspecified Identical

453.42 Acute embolism

and thrombosis of deep

veins of lower extremity

I82.41 Acute embolism and thrombosis of femoral

vein

I82.42.…….of iliac vein

I82.42……..of popliteal vein

I82.44……..of tibial vein

I82.49……..of other specified deep vein of lower

extremity

6th

character is used to indicate right, left or

bilateral

454.0 Varicose veins of

lower extremities with

ulcer

I83.00 Varicose veins of unspecified lower extremity

with ulcer

I83.001…..with ulcer of thigh

I83.002…..with ulcer of calf

I83.003…..with ulcer of ankle

I83.004…..with ulcer of heel and midfoot

I83.005…..with ulcer other part of foot

I83.008…..with ulcer other part of lower leg

I83.0- codes are combination codes with more

detail than ICD-9-CM 454.0. I83.0- codes are

differentiated first by right, left or unspecified

lower extremity, and then by the ulcer’s location

on the leg or foot

L97 code is also reported to identify the severity of

the ulcer



I83.009…..with ulcer of unspecified site

457.1 Lymphadema I89.0 Lymphedema, not elsewhere classified

Approximate

459.81 Venous

insufficiency

I87.2 Venous insufficiency (chronic) (peripheral) Identical

459.81, 707.1x Stasis ulcer

of lower extremity

I87.2 Venous insufficiency (chronic) (peripheral)

L97 Non pressure chronic ulcer of lower limb, not

elsewhere classified

L97 codes are specific for location, including right

and left, and severity, E.G. skin, fat layer exposed,

necrosis of muscle, necrosis of bone

682.6 Cellulitis/abscess leg L03.115 Cellulitis of right lower limb

L03.116 Cellulitis of left lower leg

Cellulitis and abscesses are coded with different

codes

707.03 Pressure ulcer,

coccyx

L89.15 Pressure ulcer of sacral region 6th

character specified stage

0- unstageable

1- stage 1

2- stage 2

3- stage 3

4- stage 4

9- unspecified

707.04 Pressure ulcer, hip L89.20 Pressure ulcer of unspecified hip

L89.21…..of right hip

L89.22…..of left hip

L89.4…..Pressure ulcer of contiguous site of back,

buttock and hip (5th

character indicates stage)

6th


0- unstageable

1- stage 1

2- stage 2

3- stage 3

4- stage 4

9- unspecified

707.07 Pressure ulcer heel L89.60 Pressure ulcer of unspecified heel

L89.61…..of right heel

L89.62…..of left heel

6th


0- unstageable

1- stage 1

2- stage 2

3- stage 3

4- stage 4

9- unspecified

1. TYPE □ Type I (Juvenile, brittle, due to autoimmune process, idiopathic) □ Type II (adult-onset, diabetes NOS, insulin-resistant) □ Other:

o DM due to underlying condition (identify condition): ___________________ o Chemical or drug induced (what drug or chemical): ___________________ o Other specified: _______________________________________________

2. COMPLICATIONS AND/OR MANIFESTATIONS

□ No complications or manifestations

□ Hyperosmolarity

o With nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

o Without NKHHC, with coma

□ Kidney complications (Nephropathy)

o Chronic kidney disease (stage): ______________

o With other diabetic kidney complications:__________________________

□ Ophthamic Complications (Retinopathy)

o Nonproliferative Retinopathy (mild, moderate, or severe?)

o Proliferative Retinopathy

o Macular edema

o Diabetic cataract

o With other ophthalmic complications: _____________________________

□ Neurological complications (Neuropathy)

o Diabetic Mononeuropathy,

o Diabetic Polyneuropathy,

o Diabetic Autonomic polyneuropathy,

o Diabetic Amyotrophy

o Diabetic gastroparesis

o Diabetic neuropathic arthropathy

o With other neurological complications: ____________________________

□ Circulatory complications (diabetic peripheral angiopathy)

o With gangrene

o With other circulatory complications: ______________________________

□ Other complications

o Dermatitis

o Foot ulcer (identify location of ulcer on foot)

o Other skin ulcer (identify site of ulcer)

o Periodontal disease

o Other oral complications

□ Hypoglycemia

o With coma

□ Hyperglycemia

□ Ketoacidosis

o With coma

3. Is the patient on chronic (active) insulin?

□ Yes

□ No

Documents

ICD-10-CM for Home Health Outreach StaffCMS has focused initiatives on Diabetes Diabetes is a national epidemic (CDC) ICD-10-CM codes align with the international classification systems